In this paper I am going to present some thoughts of mine on the nature of Obssessive Compulsive Disorder, as well as a possible treatment plan. I myself have OCD and have struggled with numerous manifestations of this disorder. In the process I have spent many hours thinking about the nature of OCD and how to overcome it, or at least how best to deal with it. Prior to writing this paper I have shared the main conclusions in it with a professional psychiatrist, who expressed agreement with the ideas.* From his words I suspect he was already using them in behavioral therapy before I ever thought of them. So this is not just my spur-of-the-moment ramblings on this, an admittedly highly complex issue.
We all know something of the effects of OCD; we get general ideas of it from sources such as books, TV shows, and movies. An example would be the film “As Good As It Gets”, in which the character played by Jack Nicholson has a particularly strong case of OCD. Examples of OCD’s effects are given in the opening scene of the movie: the main character enters his home and proceeds to lock his many locks, flip on and off the light switches a specific number of times, and use two bars of soap for a single washing of the hands. Many of us also learn about the effects of OCD from experiencing it firsthand.
This of course is true in my own case. I remember the first time I had a really strong manifestation of OCD was when I was a small child; I felt compelled to repeatedly utter the phrase “Hm, well, um, uh”, often as a single word “hmwellummuh”. I would do this while mentally building a pyramid of dots in my mind, and when the pyramid “felt right”, I could stop. I was so afraid this would go on and on, but thankfully it passed with time. Another, more common experience from my past would be the difficulty I had with stepping on cracks and dividing lines in the sidewalk. So most people, in America at least, have a general idea of some of the more obvious effects of OCD, either from media, experience, or some other source. This paper, however, is not primarily concerned with the effects of OCD, but rather with what causes these effects, i.e. the nature of the disorder itself.
While there are no doubt many factors which contribute to the formation of the compulsions we associate with OCD, I think there is one thing common to all of them that is most directly the cause: fear. Surprised? I was, and I had OCD for years before realizing it! I came to this conclusion in an interesting way: by watching the movie “Batman Begins”. If you pay attention, that movie is all about fear, so by the time I reached the pivotal scene my mind was already geared in the right direction for the conclusion reached. Also, I was probably thinking about my OCD and what to do about it while watching the film.
I had my eureka moment while watching a scene in the movie where Bruce Wayne has recently come back from his travels abroad and is doing work on the bat cave. In the middle of his work, a large number of bats start swirling around him. His immediate reaction is to crouch. Then, slowly and with tensed arms held slightly up and in front of him, he rises back up. This is dramatically conveyed to the audience, with appropriate music, as the moment when he finally overcomes his childhood fear of bats.
When I saw that scene, I thought to myself, “He looks just like I feel when I try to resist a compulsion.” And that’s when it hit me that fear was the driving force behind my compulsions. Fear is what makes it difficult to ignore and resist them, just as fear is what Bruce Wayne was resisting as he rose up in the middle of a storm of bats. And just as Bruce Wayne’s fear was irrational, so I believe are most if not all of the fears behind the compulsions we associate with OCD. In OCD the fear that drives compulsions is a fear of what will or of what might happen if the sufferer does not do what he feels compelled to do. That sentence bears rereading and contemplation if it is not understood by the reader the first time around.
The more I thought about it, the more it made sense in light of my experiences. My compulsion to repeat the phase “Hm, Well, Um, Uh” until it felt right? My fear in that case was that it would continue to nag at me and have long term negative effects on my mind if I didn’t get it out of my system. I was perhaps too imaginative for my own good as a child. The pyramid of dots I’m pretty sure was just an add-on compulsion which came into play a while after the initial compulsion, perhaps it was even a tool I was using to feel alright about not saying the phrase sooner. What about the cracks in the sidewalk? Classic fear for a classic compulsion: I had an irrational fear of breaking my mother’s back, or of my willfully ignoring that fear (and so not caring properly about the possible consequences to my mother’s back) causing her back to be broken, or something along those lines. Haven’t you ever heard the rhyme about stepping on a crack and breaking your mother’s back? Often the fears are subtle and easy to miss as a cause, which explains my surprise at realizing that fear was at the root of my compulsions.
Very quickly, perhaps even seconds, after reaching this conclusion a new plan for dealing with compulsions was forming in my mind. I eventually came to the conclusion that what I needed to do was recognize the irrationality or “wrongness” of my fears by reasoning about them, and then use this recognition of their irrationality to justify and enable myself to forcefully ignore the compulsions. Being a Christian I also try (successfully I believe) to utilize trust in God’s loving kindness and control when forcefully ignoring some compulsions, like the sidewalk one for instance. In coming up with the above plan of action, I reasoned that the more often I successfully resisted a compulsion, the weaker the fear that is behind the compulsion will become. Why? Because the more often I ignore a compulsion, the more my fears of what might happen if I ignore the compulsion are discomfirmed; If I keep stepping on cracks, and my mother keeps failing to break her back, the less afraid I will be that she will break her back if I ignore a compulsion and step on a crack. Consequently the compulsion itself, cut off from the fear that creates it, slowly dies a much deserved death by starvation.
I quickly realized that I wouldn’t immediately be able to ignore my compulsions all the time; the effort and execution can be a bit draining. Each time, however, that I decided to use the plan and succeeded in ignoring a compulsion, the fear would be disconfirmed and weakened, making it easier and easier with time. My sister noted that it is like a vicious cycle in reverse.** I have successfully treated a number of manifestations of OCD using this action plan. I think this success even weakens my OCD in general as I grow in confidence that behind the compulsions is irrational fear.
Some might say that it is not fear that is the underlying cause behind the compulsions we associate with OCD, but a chemical imbalance in the brain. I would agree that it may be a brain issue or brain issues that are at the ultimate root of OCD or most cases of OCD, but my claim is that fear is the thing which is “most directly the cause” of these compulsions. It seems clear to me that whatever role chemical imbalances have, they would be a more indirect cause. I think it likely that some chemical imbalance in the brain could make a person more susceptible to the kinds of fear that lead to OCD type compulsions, but it is the fear itself and not the chemicals that does the compelling.
In summary, fear, usually of the irrational variety, is what drives OCD type compulsions. Namely, fear of what might happen if the person with the compulsion does not do what he feels compelled to do. A possible treatment plan along with getting professional help is to use reason to recognize the irrationality or “wrongness” of the fears and then to use that to justify and enable the individual to forcefully resist or ignore the compulsions as often as possible. This plan weakens the compulsions over time as it weakens the fears that feed them by disconfirming the fears. I hope the reader will remember these thoughts for use in helping others or themselves to deal effectively with OCD.
* [Name removed], M.D., P.A.. Personal Interview. 14 Apr. 2010.
** [Name removed]. Online Conversation. Apr. 2010.
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